Oral Health and Dental Management of Children With Down Syndrome: A Comprehensive Review

Down syndrome (DS) is the most common chromosomal disorder associated with intellectual disability and is marked by a wide array of systemic, craniofacial, and oral manifestations. Children with DS often present with dental anomalies and a range of medical comorbidities that significantly affect oral health and dental management. This review provides a comprehensive analysis of the dental, craniofacial, airway, and anesthetic challenges commonly encountered in children with DS, highlighting their practical implications for contemporary dental practice. This narrative review synthesizes published studies, clinical guidelines, and review articles on oral health, craniofacial features, airway abnormalities, and perioperative considerations in children with DS. The synthesized evidence serves as a concise, practical resource for general dental practitioners. Children with DS frequently exhibit delayed tooth eruption, hypodontia, abnormal tooth morphology, bruxism, periodontal disease, and malocclusion. Distinct craniofacial features, including relative macroglossia, midface hypoplasia, and a high-arched palate, pose substantial functional and orthodontic challenges. Obstructive sleep apnea (OSA) is common and can complicate airway management during sedation and general anesthesia. Additionally, conditions such as atlantoaxial instability (AAI) and congenital heart disease (CHD) require meticulous preoperative assessment and coordinated multidisciplinary care. Although dental caries rates may be similar to or lower than those in the general population, periodontal disease remains a principal source of oral morbidity. Children with DS present with distinct oral, craniofacial, and medical characteristics that necessitate tailored dental care. Early implementation of preventive measures, ongoing dental monitoring, and robust collaboration among dental and medical professionals are essential for optimizing oral health, ensuring safe and effective treatment, and enhancing quality of life.